Katsuji Yamauchi

Laparoscopic ovarian cystectomy using a single umbilical puncture method.

To establish a minimally invasive technique to perform ovarian cystectomy, the authors applied a single umbilical puncture method. A 2-month old female infant was admitted to the hospital because of an ovarian cyst that showed no spontaneous shrinkage after her birth. An umbilical semicircular incision was made to insert a 10-mm trocar, into which a 3-mm laparoscope was inserted. The ovarian cyst was grasped using forceps inserted through an operating channel of the scope, and the cyst was removed through the incision. After aspiration of the cyst, the free cyst wall was resected, leaving the intact ovarian tissue. The operation was performed without difficulty or complication. The postoperative course was uneventful. The wound was inconspicuous, and the result was cosmetically excellent. The case demonstrated the feasibility of the minimally invasive technique using a single umbilical puncture for ovarian cystectomy in an infant.

Effect of electrolyzed strong acid water on peritoneal irrigation of experimental perforated peritonitis

PurposeElectrolyzed strong acid water (ESAW) is generated by the electrolysis of a weak sodium chloride solution. Although ESAW is known to have a strong bactericidal activity and to be harmless to the living body, its effectiveness and safety in the treatment of perforated peritonitis has not been well established.MethodsMale Wistar rats were used for the study. Three hours after cecal ligation and puncture, the cecum was resected and the peritoneal cavity was irrigated with 50 ml of saline (Group S, n=12) or ESAW (Group E, n=14). The 5-day survival rate was compared between the two groups. In another pair of animals (n=10 each), bacteria in the ascitic fluid were counted at 6 and 18 h after irrigation.ResultsNo adverse effects of ESAW were observed in the experimental group. The 5-day survival rate was 25% (3/12) and 85.7% (12/14) in Groups S and E, respectively (P < 0.01). The bacterial count at 18 h after the irrigation in Groups S and E was (5.0 ± 2.5) × 105/ml and (2.2 ± 2.0) × 104/ml, respectively (P < 0.0001).ConclusionPeritoneal lavage with ESAW had no adverse effect, and achieved more effective decontamination than saline for perforated peritonitis. Therefore, the results of this study are considered to warrant and support the clinical application of ESAW.

Laparoscopic treatment of gallbladder volvulus: a pediatric case report and literature review.

Volvulus of the gallbladder has been reported mostly in elderly women and is rarely reported in children. In this paper, we report a recent case of successful detorsion and removal of the gallbladder via minimal access surgery, which was diagnosed as gallbladder volvulus preoperatively by means of magnetic resonance imaging (MRI). An 11-year-old boy presented with an acute abdomen, and acute cholecystitis was suspected, based on the findings of ultrasound and computed tomography. However, a diagnosis of gallbladder volvulus was established through MRI, and emergency laparoscopic surgery was subsequently performed. Laparoscopy revealed a hemorrhagic, gangrenous gallbladder that floated anteriorly. The gallbladder was rotated twice around its pedicle in a counterclockwise direction. It was untwisted through laparoscopy, and a cholecystectomy was performed without difficulty. To achieve an early, prompt preoperative diagnosis, MRI could be an effective alternative to conventional imaging modalities. The advent of laparoscopic detorsion and cholecystectomy as a treatment for gallbladder volvulus allows less invasive treatment, a shorter hospital stay, and better cosmesis, which are highly desirable in children.

Laparoscopic intervention for intrathoracic stomach in infants

Background: Intrathoracic stomach is an uncommon condition in infants. We report our experience managing such a condition successfully by laparoscopy in four patients. Methods: Patients’ ages at the time of operation ranged from 30 days to 14 months. In all cases, the intrathoracic stomach was easily pulled down into the abdominal cavity. The phrenoesophageal ligament was completely resected, and the enlarged hiatus was narrowed by intraabdominal suturing technique. The esophagus was wrapped with the mobilized fundus in a floppy fundoplication. Anchoring sutures were placed between the wrapping cuff and crura. Result: One patient had paraesophageal hernia (type 2), whereas the other had combined hiatal hernia (type 3). No adverse complications were observed in any of the cases. Symptomatic gastroesophageal reflux and radiographic recurrence of hernia were not seen in any case. The cosmesis was excellent in all cases. Conclusions: We conclude that laparoscopic repair for intrathoracic stomach is a safe and feasible method when preoperative evaluation is conducted adequately.

An unusual presentation of congenital infantile myofibromatosis arising from the interspinous ligament

Abstract The authors describe an extremely rare presentation of congenital infantile myofibromatosis. A full-term newborn boy presented with a thumb-sized subcutaneous mass on the mid-spinal line between the 2nd and 3rd lumbar spinous processes. A solid tumor arising from the interspinous ligament was resected. Microscopic and immunohistochemical studies revealed myofibromatosis.

Application of Single-Puncture Technique to Laparoscopy-Assisted Surgery in Children

Purpose: In order to establish a minimally invasive and cosmetically satisfactory technique to perform laparoscopy-assisted surgery, we applied a single-puncture method to pediatric cases; i.e., ovarian cyst, vitelline duct remnant, and cerebral palsy with inappropriate oral intake. Methods: Ovarian cystectomy was performed through a semicircular umbilical incision employing a laparoscope with an operating channel for grasping forceps. For a vitelline duct remnant, definitive diagnosis and subsequent total resection of the remnant were performed through an umbilical arcuate incision. For inappropriate oral intake, through a tiny incision in the left hypochondrium, a laparoscope with grasping forceps was inserted to grasp the gastric or jejunal wall. After the gastric or jejunal wall was pulled out of the incision, gastrostomy and jejunostomy were performed in the same manner as with open surgery in six and one cases, respectively. Results and Conclusions: In all cases, the operations were performed safely...

Acquired cryptorchidism in a boy with disorder of sex development.

Recently, it has been reported that boys with severe hypospadias are at increased risk for acquired cryptorchidism. The reports suggested that prenatal and postnatal androgen disruption might be correlated with this condition. We experienced a case of ovotesticular disorder of sex development (DSD), which was ultimately diagnosed at surgery for acquired cryptorchidism. Ascent of the scrotal contents of the left side was detected in a 7-yr-old boy with the 46, XX karyotype, who had a history of perineal hypospadias repair. Intraoperative findings revealed the left gonad consisted of 2 segments, and this was histologically diagnosed as ovotestis by biopsy specimen. Resection of the ovarian segment was performed simultaneously. Exploration of the contralateral gonad showed the same findings. This is the first report of acquired cryptorchidism observed in a patient with DSD presenting with ambiguous genitalia.

Application of a drug delivery system in a novel rat model of chronic hyperendotoxemia.

Abstract There has not been an ideal reproducible small-animal model of chronic hyperendotoxemia to date. Our drug delivery system (DDS) is a new technology that can deliver a drug conveniently to a target organ at an optional rate. 2-Hydroxyethyl methacrylate (HEMA) was used as a carrier of lipopolysaccharide (LPS), and diethylene glycol and polyethylene glycol dimethacrylates (2G, 4G, 9G) were used as cross-linking agents. A mixed solution of HEMA and di(poly)ethylene glycol dimethacrylate was charged into a glass tube with or without LPS and polymerized by ultraviolet irradiation. This polymer was cut into DDS tablets of the same size with or without LPS. A mixture with HEMA:4G=1:3 was the most suitable composition to release a constant concentration of LPS. We also developed a novel rat model of chronic hyperendotoxemia. Four DDS tablets, each containing 15 mg LPS, were implanted into the abdominal cavity of rats in the LPS group. The control group was implanted with four DDS tablets without LPS. Plasma levels of LPS in the study group were maintained at more than 2,000 pg/ml for 72 h after implantation. Weight gain was lower and body temperature was higher in the LPS group than in the control group. Plasma levels of inter leukin (IL)-6 in the LPS group were higher than in the control group only during the initial 12 h after implantation of DDS tablets. The white blood cell count at 24 h and platelet counts at 24, 48, and 72 h in the LPS group were lower than those in the control group. These results indicate that chronic hyperendotoxemia was maintained for 72 h by continuous release of LPS from the DDS. Moreover, the intensity of endotoxemia could be varied by varying the number of DDS tablets. It is concluded that our new rat model using LPS–DDS will be applicable and useful as a model of chronic hyperendotoxemia.

A novel approach to neonatal abdominal surgery via a circular incision around the umbilical cord

We present a new, scarless, circular incisional approach around the umbilical cord for neonates with intestinal atresia. This novel approach achieves truly woundless surgery. It is simple, safe, and can be used for an intestinal surgical treatment in neonates.

Anterior mediastinal tracheostomy with a median mandibular splitting approach in a Larsen syndrome patient with posterior cervical arthrodesis

Larsen syndrome is a rare congenital connective tissue disorder characterized by multiple joint dislocations. A novel anterior mediastinal tracheostomy with a median mandibular splitting approach is presented for the treatment of airway obstruction in a Larsen syndrome patient with posterior cervical arthrodesis.